Evaluation of Dialysis Access Issues Research Paper

Evaluation of Dialysis Access Issues Research Paper

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Evaluation of Dialysis Access Issues Research Paper

Dialysis Access

Metropolitan Hospital has a large dialysis program. Many patients have dialysis access issues where they need to have their access sites fixed on an urgent or emergent basis. These access sites are catheters, arterial venous fistulas, or arterial venous grafts that have been placed in the patient for connection to the dialysis machine. Dialysis is life sustaining for patients in renal failure; access sites are literally lifelines.

Mr. Cavanaugh presented to the hospital dialysis center with a clotted dialysis graft. The surgeon was contacted and the patient was sent to the preoperative area. The patient had not been dialyzed in four days and the patient had not eaten that day.

When the nurse received the results of the required routine blood work, she noted that the potassium was quite elevated. The nurse called the operating room and stated the case had to be canceled.

Dr. Jones, the surgeon, was outraged. He phoned the operating room and the nurse. An argument ensued, and words were exchanged. The nurse stated that it was unsafe to send the patient to the operating room with a high potassium level, because the patient could arrest.

The surgeon stated the patient needed dialysis in order to lower the potassium. If Dr. Jones did not fix the dialysis access, the patient’s potassium would only get higher, which could be life threatening.

Finally, after a lengthy discussion with the anesthesiologist, the patient, and the nurse, reason prevailed and the dialysis access was appropriately repaired. The patient was monitored throughout the procedure by an anesthesiologist with no adverse outcome.

Discussion Questions

1. What are the facts in this situation?
2. What could have been done to avoid this confrontation?
3. What are three organizational issues this case illustrates?
4. Should the nurse have attempted to cancel the surgery without speaking to the surgeon?
5. What steps should be taken in the future to prevent this problem from occurring again?
6. Should other people have been involved in resolving this dispute? If yes, what roles could they have played in this resolution?
7. Have you ever been involved in an ugly confrontation with a coworker? Looking back at that incident, knowing what you now know, what might you have done differently? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

ADDITIONAL RESOURCES

Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.

Fallon, L. F., & McConnell, C. R. (2007). Human resource management in healthcare: Principles and practices. Sudbury, MA: Jones and Bartlett.

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.

Ricci, M. A., & Brumstead, J. R. (2012, April). Crew resource management: Using aviation techniques to improve operating room safety. Aviation Space and Environmental Medicine, 83(4), 441–444.

Rogers, D., Lingard, L., Boehler, M. L., Espin, S., Klingensmith, M., Mellinger, J. D., & Schindler, N. (2011). Teaching operating room conflict management to surgeons: Clarifying he optimal approach. Medical Education, 45(9), 939–945.

Siu, H., Spence Laschinger, H., & Finegan, J. (2008). Nursing professional practice environments: Setting the stage for constructive conflict resolution and work effectiveness. The Journal of Nursing Administration, 38(5), 250–257.

RUBRIC
Excellent Quality 95-100%	Introduction 45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.		Literature Support 91-84  points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.			Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score 50-85%	40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.		83-76  points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.			52-49  points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality 0-45%	37-1 points The background and/or significance are missing. No search history information is provided.		75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.			48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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